Tubal ligation is a surgical procedure that is used as a means to
achieve (mostly) permanent infertility in women. As a means of sterilization
it is very effective, with only a 0.4% rate of failure (which can mostly be
attributed to human error on the part of the surgeon). It literally means
"tying of the tubes," thus the common phrase "getting your tubes
tied." However, the procedure itself can involve any form of tying,
cutting, or blocking.
It is estimated that one in three (33.33%) women who have this procedure
change their mind at a later date and want to become pregnant. While reversal
procedures are done, they are very expensive (around US$10,000) and there is no
guarantee that the woman will be able to conceive even if the tubes are
successfully reconnected/unblocked. It is, therefore, not something to be taken
lightly, as other means of contraception exist that are truly reversible.
Conversely, there are of course good, medical reasons to choose this procedure.
If a (or another) pregnancy would endanger the health of the mother (as with
juvenile diabetes, for example), then such a relatively extreme form of
contraception is warranted. And, of course, there is nothing wrong with
choosing this procedure, but it should be something that you are
absolutely certain about (e.g. you have a moral conviction
against bringing more children into this world).
Other health concerns must also be considered before this procedure. The
procedure can lead to several serious complications such as ectopic pregnancy, menstrual cycle disturbances - increased pain or bleeding, and other gynecological problems that may lead to the need for a hysterectomy.
Surgical Techniques
Source: R. A. Hatcher et al., "Contraceptive Technology," 16th
Revised Ed., Irvington Publishers, 1994. p. 386.
The general idea behind all of the following procedures is to prevent eggs
from passing through the fallopian tubes to the uterus.
Pomeroy
The most common of the techniques, Pomeroy involves cutting off the flow
of blood to a folded segment of the fallopian tube, causing a section of the
tube to necrose and be resorbed by the body. This creates the desired break
in the tube when healed. Generally speaking, there is no risk of infection
during the necrosis, unless the patient is or becomes septic. A variation of
this technique involves resecting (cutting) the folded segment to assist the
body in healing. A further variation involves cauterizing the ends
of the tubes to seal them.
Irving
This technique severs the fallopian tube at the midpoint and folds the section
of the tube closest to the uterus back upon itself, thereby preventing any
possibility of spontaneous reattachment of the two segments of the tube.
Pritchard/Parkland
This technique excises a section of the fallopian tubes, ties off both ends,
and allows them to heal, thus creating the desired break in the tube.
Fimbriectomy
As its name implies, this technique excises the fimbriae entirely, thus
preventing the egg from entering the fallopian tube at all.
Uchida
This technique excises almost the entire fallopian tube, tying off the
"stump" at the uterus.
"Reversible" Tubal Ligation
This technique, once touted as a "reversible" procedure, uses either a
spring clip or a silastic ("falope") ring to pinch off the tube so
as to prevent the passage of the egg. When the spring clip is used, the tube is
simply pinched off; with the silastic ring, a section of the tube is looped
and then pinched off. This technique has a couple of innate problems:
- it is not always wholly successful (eggs can pass though the clip/ring if
they are not properly used);
- the technique is not always as reversible as it was sometimes advertised (sometimes the tissue at the site of the clip/ring necroses and is resorbed, so you end up with a situation similar to the Pomeroy technique)